Abdomenal pain, severe jaundice years after gall bladder removal

Hello,

I am a 36 year old male with hemolytic anemia caused by Pyruvate Kinase Deficiency.  My hemoglobin runs normally ~8g and my bilirubin levels ~3g.  I received a spenectomy at age 4, and my gallbladder was removed at age 19 back in 1991 when I had evidence of pigment stones and a blockage in my common bile duct.  I received an ERCP procedure back in 1991 to clear the common bile duct, and developed severe pancreatitus (pancreatitis) afterward where my bilirubin levels shot up to 30.  I also had my gallbladder removed laproscopically.    

Since 1991, I have had no more episodes of abdominal pain or jaundice.  However, since February 2006, I have had at least 12 episodes of severe pain, vomiting, sometimes fever, severe jaundice (bilirubin >10), elevated liver enzymes. I had an ERCP in August 2006 to remove a blockage from my common bile duct, but no root cause was given as to the formation of the blockage.  The GI found sludge, but no pigment stones.  I again received an ERCP in October 2007 to remove sludge, but I developed a moderate case of pancreatitus (pancreatitis) following the procedure.  

Since October 2007, I have had at least 4 more episodes of pain, fever, vomiting and jaundice, and I was hopitalized again on June 24, 2008 for severe abdominal pain and jaundice, but I'm convinced that another ERCP will not solve my problem.  After doing research on this forum, I believe that I have some type of "stricture" in my common bile duct that is limiting the flow of bile and potentially causing infection.  The GI doctors in the hospital are telling me that I am having recurring "hemolytic crisis" which is causing pain and jaundice.  However, I never have had this issue since 1991 until a few years ago.  My brother has the same disease, and he had his gallbladder removed through the convential surgery, and he has never had any issue since.  

Anyway, I'm looking for suggestions as to what might be causing my recurring problem.  What tests can be done to identify the cause?


Thanks!

-Dan

[AlanPi]

Lookup Sphincter of Oddi & Sphincterotomy, it may be related.  Hope this helps...

[AlanPi]

Also "Ducts of Luschka"